Statin-free supplement? Not quite

Could you review red yeast rice? I've started taking it in an attempt to lower my cholesterol and stay off statins.

Diana

Sherman Oaks

The products: Lowly fungi have an amazing ability to create compounds that have strong effects on humans (alcohol, hallucinogens and antibiotics, to name a few). As far back as the Tang dynasty in 800, the Chinese harvested a red extract produced by certain types of fungi growing on rice. The fermented rice itself -- so-called "red yeast rice" -- was prized as a remedy for stomach troubles.

Today, red yeast rice enjoys wide acclaim as a cholesterol-lowering supplement that's a natural alternative to prescription statin drugs such as Lipitor and Zocor. Prescription statins can cut LDL cholesterol levels by 50% or more -- a potentially lifesaving result -- but many consumers worry that the drugs will cause muscle pain, a complication that occurs in up to 5% of users.

Such concerns have created a market for a variety of red yeast rice capsules, which are widely available at health food stores and over the Internet. Among the options: One can buy 90 600-milligram capsules of Solaray red yeast rice for about $20. (Follow the instructions -- one capsule twice a day -- and they'll last 45 days.) Expect to pay about $30 for the same capsules from Nature's Plus, which recommends taking one capsule each day.

The claims: The Solaray website touts red yeast rice as "a powerful tool in lowering cholesterol and heart disease risks." The website of the supplement company Vitabase claims that red yeast rice is clinically proven to reduce LDL cholesterol by about 20%.

The bottom line: First things first. If you're hoping to avoid statins, red yeast rice may not be the product for you. The industrious fungi growing on rice are actually little pharmaceutical factories creating a natural supply of monacolin K, also known as lovastatin. As the suffix suggests, lovastatin is a bona fide statin drug. The first to hit the market, it's sold under the name Mevacor and is now available as a generic.

Secondly, nature isn't always precise, and different batches of red yeast rice probably contain different levels of lovastatin. In fact, by the standards of the Food and Drug Administration some brands of red yeast rice have enough lovastatin to cross the line between nutritional supplements and unapproved drugs. Studies of red yeast rice have shown "impressive" results, says Joe Dixon, an associate professor with the Center for Lipid Research at Rutgers University in New Brunswick, N.J. Dixon has evaluated all sorts of alternative products for cholesterol -- including walnuts and soluble fiber -- and he says red yeast rice stands out.

In one high-profile study published in the American Journal of Clinical Nutrition in 1999, 83 people with high cholesterol took either 2,400 milligrams of red yeast rice or a placebo every day for three months. At the end of the study, the group taking red yeast rice had, on average, cut about 50 points from their LDL cholesterol -- a reduction of about 20%.

If patients could somehow re-create that experiment, Dixon says, they'd definitely be getting their money's worth from red yeast rice. But because nutritional supplements are not standardized and largely unregulated, "one never knows what dose is in a particular product," he adds. In contrast, prescription lovastatin is highly consistent and predictable.

Studies generally find that patients taking red yeast rice enjoy about the same benefits as patients taking a daily low dose (20 milligrams) of lovastatin, says Thomas Allison, a cholesterol expert at the Mayo Clinic in Rochester, Minn. Unfortunately, because users are still dealing with a statin, they also face the same risks, including muscle pain. "I've had patients who tried red yeast rice," Allison says. "If they had a side effect on statins, they got it from red yeast rice too."

Concerned about the high levels of lovastatin in some products, the FDA in August banned the sale of Cholestrix, a red yeast rice supplement sold by Sunburst Biorganics, and two other red yeast rice supplements sold by Swanson Health Products. The FDA reports that the levels of lovastatin found in the products could be high enough to cause kidney damage, a rare complication of statins.

According to Allison, there's still one all-natural, side-effect free way to cut high cholesterol: Go easy on saturated fats while eating plenty of fruits, vegetables and whole grains. If that isn't enough, your doctor will probably recommend a statin -- the prescription variety, that is.

Fungi make some great products, but, according to Allison, it's best to leave your cholesterol medications to the professionals.

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